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Surgery Clerkship Exam Questions With Complete Solutions
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Surgery Clerkship Exam Questions With Complete Solutions
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Surgery Clerkship Exam Questions With CompleteSolutions
14 year old girl brought to ED for evaluation of acute right knee
pain. She dismounted the balance beam and landed awkwardly
and collapsed to the ground. She heard an audible pop and has
been unable to straighten the knee since. Right knee is flexed
with decreased ROM, significant swelling and tenderness over
the medial side. Lateral aspect of the knee has a large, painful,
immobile deformity. Palpation reveals divot over the trochlea
and minimal pain over the tibial tuberosity. Correct Answer
Patella dislocation
19 year old woman with recurrent headaches, BP 175/100,
systolic bruit under right ear. Correct Answer Fibromuscular
dysplasia leading to internal carotid artery stenosis and
hypertension secondary to renal artery stenosis
3 week hx of SOB, mild pain in right chest wall and
nonproductive cough. 12lb weight loss during past 3 months.
PMH of carcinoma of rt. breast 6 years ago and underwent
lumpectomy followed by radiotherapy and chemotherapy.
Breath sounds decreased on the right with dullness to
percussion. Friction rub heard at the right. Heart sounds normal.
Correct Answer Malignant pleural effusion
30 y/o male with mass gradually enlarging at a port site from lap
colon resection for FAP. Not painful, firm 1.5 cm mass on
exam. Best initial therapy is?
A. Immediate wide local incision and reconstruction
,B. Incisional biopsy
C. CT scan of abdomen and pelvis
D. Line placement and initiation of chemotherapy Correct
Answer C
CT scan of the abdomen and pelvis is indicated to allow for
measurement and
define extent of tumor and identification of any intraabdominal
or retroperitoneal
desmoids.
B, Core needle biopsy is the biopsy of choice rather than
incisional biopsy.
A, Local excision is reserved for tumors which have mass effect
or are not responsive to
medical therapy.
D, Medications helpful for the treatment of desmoid tumors
include estrogen receptor antagonists and nonsteroidal
medications which do not require IV access, so initial line
placement is not necessary.
32-year-old man underwent laparotomy for trauma because of
multiorgan injuries. He was discharged after 2 weeks in the
hospital only to be readmitted after 3 days because of abdominal
pain and sepsis. The CT scan showed an accumulation of fluid
,in the subhepatic space. This space is likely to be directly
involved following an injury to which of the following?
A
Inferior pole of the right kidney
B
Stomach
C
Superior mesenteric artery
D
Inferior mesenteric vein
E
Right psaoas muscle Correct Answer B
Subhepatic space infection usually occurs after surgery or
peritonitis in the supracolic compartment. It is an unlikely
complication of biliary pancreatitis. Infections in the subhepatic
space may extend to the infracolic compartment via the
paracolic gutter (of Morrison). This implies a perforation of the
stomach.
34-year-old in the ICU s/p laparotomy with fascia closed,
decreased urine output, increased peak airway pressure,
decreased CVP, normal chest x-ray, normal EKG Correct
Answer Abdominal compartment syndrome
, 35 y/o hx of injection heroin use, intramuscular naloxone
administered by EMS personnel but failed to improve condition.
Febrile, ptosis of both eyes, dilated pupils, unable to hold head
up, respirations are shallow. Lungs CAB, heart RRR, abdomen
soft and nontender, two abscesses are present on the left thigh.
Blood gas reveals hypoxia and acute respiratory acidosis. Next
best step in management? Correct Answer Equine botulinum
antitoxin
Wound botulism from contaminated puncture wound i.e.
injection drug use.
4 day hx of progressive back pain and weakness and numbness
in legs. Has not urinated for 12 hours. Hyperreflexive in knees
and ankles. Babinski is upgoing bilaterally. Sensation to
pinprick is decreased below the nipples and sensation to
vibration is absent in LE. Unable to walk. Location of lesion?
Correct Answer Thoracic spinal cord
5 days post-op, sudden onset of SOB. Patient is febrile, tachy,
hypotensive, JVD. Crackles heard of midlung fields. No
murmurs or rubs on exam. Hepatomegaly present. ECG shows
ST-segment elevation in anterior leads. Likely diagnosis?
Correct Answer Cardiogenic shock
50-year-old man with small-bowel fistula has been receiving
TPN for the previous 3 weeks through a single-lumen central
venous catheter. He is scheduled for exploratory laparotomy and
closure of fistula. On the morning of the day of surgery, TPN is
discontinued and intravenous infusion with balanced salt
solution (Ringer's lactate) is started. An hour later, the patient is
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